Healthcare provider and patient perspectives on access to and management of atrial fibrillation in the Northern Province, Sri Lanka: a rapid evaluation of barriers and facilitators to care
Posted on 2022-08-24 - 06:59
Abstract Background Atrial fibrillation (AF) is the most common cardiac arrhythmia that affects 60 million people worldwide. Limited evidence on AF management exists from low- and middle-income countries and none from Sri Lanka. We aimed to investigate the existing AF care pathway and patients’ perception on AF management to identify barriers and enablers for optimal AF care in Northern Province, Sri Lanka. Methods A rapid evaluation was undertaken with use of qualitative methods. Local healthcare providers (HCPs) mapped the intended pathway of care for AF patients which was then explored and annotated through 12 iterative sessions with additional HCPs. Topics of inefficiencies identified from the finalised map were used to guide focus group discussions (FGDs) with AF patients. AF patients who were attending the anticoagulation clinic at the only tertiary hospital in Northern Province were recruited and invited to participate using purposive sampling. The topic guide was developed in collaboration with local clinicians and qualitative experts. FGDs were conducted in the native Tamil language and all sessions were recorded, transcribed verbatim and thematically analysed using a deductive approach. Results The mapped pathway revealed inefficiencies in referral, diagnosis and ongoing management. These were explored through three FGDs conducted with 25 AF patients aged 25 to 70 years. Two key themes that contributed to and resulted in delays in accessing care and ongoing management were health seeking behaviours and atomistic healthcare structures. Four cross-cutting sub-themes identified were decision making, paternalistic approach to care, cost impacts and lifestyle impacts. These are discussed across 10 unique categories with consideration of the local context. Conclusions Strengthening primary healthcare services, improving public health literacy regarding AF and building patient autonomy whilst understanding the importance of their daily life and family involvement may be advantageous in tackling the inefficiencies in the current AF care pathway in Sri Lanka.
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Sheron, Vethanayagam Antony; Shanmugathas, Shivany; Gooden, Tiffany E.; Guruparan, Mahesan; Kumarendran, Balachandran; Lip, Gregory Y. H.; et al. (2022). Healthcare provider and patient perspectives on access to and management of atrial fibrillation in the Northern Province, Sri Lanka: a rapid evaluation of barriers and facilitators to care. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.6162906.v1
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AUTHORS (17)
VS
Vethanayagam Antony Sheron
SS
Shivany Shanmugathas
TG
Tiffany E. Gooden
MG
Mahesan Guruparan
BK
Balachandran Kumarendran
GL
Gregory Y. H. Lip
SM
Semira Manaseki-Holland
KN
Krishnarajah Nirantharakumar
KS
Kaneshamoorthy Shribavan
KS
Kumaran Subaschandren
RH
Rashan Haniffa
RS
Rajendra Surenthirakumaran
GT
G. Neil Thomas
PU
Powsiga Uruthirakumar
SG
Sheila Greenfield
DL
Deirdre A. Lane
AB
Abi Beane